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Made available in DSpace on 2014-06-11T19:23:47Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-02-18Bitstream added on 2014-06-13T19:30:23Z : No. of bitstreams: 1 heckler_mct_me_botfmvz.pdf: 419721 bytes, checksum: ca827eb861ab5e1b806340c29480f90f (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / O estudo avaliou o desempenho de cães adultos em testes cognitivos, para posteriormente identificar e monitorar alterações cognitivas em cães idosos, além de verificar a viabilidade e selecionar um dos testes para utilização na rotina clínica. Foram utilizados 15 cães adultos hígidos para os testes cognitivos de abordagem à recompensa, abordagem ao objeto, discriminação do objeto, aprendizado reverso, atraso não ligado à posição e atraso não ligado à amostra. Não houve diferença significativa no desempenho quanto ao número de dias quando comparados machos com fêmeas, cães de idade inferior ou superior a quatro anos, cães de peso inferior ou superior a 20 kg, e ainda cães treinados no ambulatório ou em sua própria casa em nenhum dos testes realizados. Os testes de atraso não ligado à posição (DNMP) e de atraso não ligado à amostra (DNMS) não apresentaram diferença significativa entre si. Já a comparação dos testes de discriminação do objeto com o aprendizado reverso apresentou diferença significativa. Conclui-se que o sexo, a idade analisada, o porte e o ambiente do animal não tiveram influência significativa no desempenho dos cães nos testes realizados. O teste de discriminação do objeto foi mais fácil aos cães do que o aprendizado reverso e os testes de DNMP e de DNMS apresentaram dificuldade semelhante aos cães. Sugere-se o teste de DNMP para ser utilizado na rotina clínica para avaliação de cães com alterações cognitivas por ser sensível e de rápido aprendizado / This paper evaluated the performance of adult dogs in cognitive tests, to after identify and monitor cognitive changes in older dogs, to verify viability and select one of the tests to use in clinical practice. 15 healthy adult dogs were used for the cognitive tests of reward approach learning, object approach learning, object discrimination learning, reversal learning, delay non-matched to position and delay non-matched to sample. There was no significant difference on number of days in performance when compared males with females, dogs younger or older than four years, dogs weighing less or more than 20 kg, and still trained dogs in the clinic or at home in any of the tests. The tests of delay non-matched to position (DNMP) and delay non-matched to sample (DNMS) showed no significant difference between them. The comparison between object discrimination test and reversal learning showed significant difference. We conclude that sex, age, size and environment of the animal had no significant influence on the performance of dogs in tests. The object discrimination test was easier to dogs than reversal learning and DNMP and DNMS had similar difficulty to the dogs. DNMP test is suggested to be used for routine clinical evaluation of dogs with cognitive impairments since it is sensitive and quickly learned

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AIMS: Substance use and dependence is very common among people living with HIV-infection. Since substances like alcohol and marijuana as well as the HIV virus itself are believed to have negative effects on cognition and the brain, our aim was to test the hypothesis that current and lifetime marijuana and heavy alcohol use are associated with cognitive dysfunction in people with HIV-infection. METHODS: Boston ARCH cohort participants consisted of 215 HIV-infected adults with substance dependence or current or past injection drug use. In cross-sectional, regression analyses we tested the association between current marijuana use (number of days marijuana was used in the past 30 days), current heavy alcohol use (number of heavy drinking days in the past 30 days defined as ≥4 drinks for women and ≥ 5 for men in 24 hours), lifetime marijuana use (number of years marijuana was used ≥ 3 times per week), lifetime alcohol use (total Kg), duration of heavy alcohol use (# of years alcohol was use > 84 grams or > 6 drinks per day), and three measures of cognitive dysfunction: i) memory and ii) attention domains of the Montreal Cognitive Assessment (MoCA), and iii) 4-item cognitive function scale (CF4) from the Medical Outcomes Study HIV Health Survey (MOS-HIV, range 0-100). Eight multivariable models were fit comparing: 1. current marijuana use by each cognitive outcome, 2. current heavy alcohol use by each cognitive outcome, 3. lifetime marijuana use by each cognitive outcome, 4. lifetime alcohol use (Kg) by each cognitive outcome, 5. lifetime marijuana use, duration of heavy alcohol use, current heavy alcohol use, and current marijuana use by each cognitive outcome, 6. lifetime marijuana use, lifetime alcohol use (Kg), current heavy alcohol use, and current marijuana use by each cognitive outcome, 7. the interaction between current marijuana and heavy alcohol use by each cognitive outcome, and 8. the interaction between lifetime marijuana and lifetime alcohol use (Kg) by each cognitive outcome. Analyses were adjusted for demographics, primary language, comorbidities, depressive symptoms, anxiety, antiretroviral therapy, HIV-viral load, CD4 count, lifetime cocaine use, cocaine use in the past 30 days, illicit opioid use in the past 30 days, and any prescribed opioids. RESULTS: Participant characteristics were as follows: Mean age 49 yrs., 35% female, 20% white, 66% ≥ 12 years of education, 86% English as primary language, 82% unemployed, mean Charlson comorbidity score 2.9, 28% scored ≥ 3 on the PHQ-2 indicating depressive symptoms, 44% scored ≥ 8 on OASIS indicating symptoms of anxiety, 58% had Hepatitis C infection at some point in their life, 86% were on HAART, 72% had an HIV-viral load < 200 copies/mL, CD4 cell count/mm3 was 10% <200 and 33% 200 - <500, mean HIV duration was 16 years, lifetime cocaine use was 9 years, 30% used cocaine in the past 30 days, 25% used illicit opioids in the past 30 days, and 61% were prescribed opioids. Current marijuana use was significantly associated with a lower MOS-HIV CF4 score in three of the fully adjusted models (1,5, and 6) listed previously with a decrease in 0.30 points for every day of use, but neither MoCA score. Current heavy alcohol use was also associated with a higher MOS-HIV CF4 score in model 5, increasing 0.36 points for every day of use. This finding did not confirm our hypothesis and in fact was opposite our projections. Lifetime marijuana use and lifetime alcohol use were not associated with any measure of cognitive dysfunction, and there was no interaction between lifetime marijuana use and lifetime alcohol use with cognitive dysfunction, and no interaction between current marijuana use and current alcohol use with cognitive dysfunction. CONCLUSION: Current marijuana use may be associated with cognitive dysfunction. We also detected an unexpected association between current heavy alcohol use and better cognitive function, but it is not biologically plausible. However, we did not detect associations between lifetime alcohol or marijuana use and cognitive dysfunction among people with substance dependence and HIV-infection. Further research, particularly on long-term exposure to substances, should include subtler measures of cognitive dysfunction and consider whether or not cognitive dysfunction that may be the consequence of marijuana and alcohol use is detectable among those who have many other factors effecting cognition. These results suggest that marijuana use should not be considered benign for individuals with substance dependence and HIV-infection.

Orientador: Rogério Martins Amorim / Banca: Silvia Mitiko Nishida / Banca: Mauro Lantzman / Resumo: O estudo avaliou o desempenho de cães adultos em testes cognitivos, para posteriormente identificar e monitorar alterações cognitivas em cães idosos, além de verificar a viabilidade e selecionar um dos testes para utilização na rotina clínica. Foram utilizados 15 cães adultos hígidos para os testes cognitivos de abordagem à recompensa, abordagem ao objeto, discriminação do objeto, aprendizado reverso, atraso não ligado à posição e atraso não ligado à amostra. Não houve diferença significativa no desempenho quanto ao número de dias quando comparados machos com fêmeas, cães de idade inferior ou superior a quatro anos, cães de peso inferior ou superior a 20 kg, e ainda cães treinados no ambulatório ou em sua própria casa em nenhum dos testes realizados. Os testes de atraso não ligado à posição (DNMP) e de atraso não ligado à amostra (DNMS) não apresentaram diferença significativa entre si. Já a comparação dos testes de discriminação do objeto com o aprendizado reverso apresentou diferença significativa. Conclui-se que o sexo, a idade analisada, o porte e o ambiente do animal não tiveram influência significativa no desempenho dos cães nos testes realizados. O teste de discriminação do objeto foi mais fácil aos cães do que o aprendizado reverso e os testes de DNMP e de DNMS apresentaram dificuldade semelhante aos cães. Sugere-se o teste de DNMP para ser utilizado na rotina clínica para avaliação de cães com alterações cognitivas por ser sensível e de rápido aprendizado / Abstract: This paper evaluated the performance of adult dogs in cognitive tests, to after identify and monitor cognitive changes in older dogs, to verify viability and select one of the tests to use in clinical practice. 15 healthy adult dogs were used for the cognitive tests of reward approach learning, object approach learning, object discrimination learning, reversal learning, delay non-matched to position and delay non-matched to sample. There was no significant difference on number of days in performance when compared males with females, dogs younger or older than four years, dogs weighing less or more than 20 kg, and still trained dogs in the clinic or at home in any of the tests. The tests of delay non-matched to position (DNMP) and delay non-matched to sample (DNMS) showed no significant difference between them. The comparison between object discrimination test and reversal learning showed significant difference. We conclude that sex, age, size and environment of the animal had no significant influence on the performance of dogs in tests. The object discrimination test was easier to dogs than reversal learning and DNMP and DNMS had similar difficulty to the dogs. DNMP test is suggested to be used for routine clinical evaluation of dogs with cognitive impairments since it is sensitive and quickly learned / Mestre

Previous studies suggested that the Functional Activities Questionnaire (FAQ-10) has minimal ethnic bias and that a shorter version (FAQ-6) can equally diagnose MCI and dementia. Objective: We analyzed whether FAQ-6 is similar to FAQ-10 in diagnosing MCI and dementia. We examined their applicability across European Americans (EA) and Hispanic Americans, and how scores correlated to beta amyloid. Method: 222 participants (116 EA) completed a neuropsychological battery, FAQ, and PET scans, and were classified as cognitively normal (CN), MCI, or dementia. The diagnostic capacity of FAQ-10 and FAQ-6 were compared for the total sample and across ethnic groups. Scores were correlated to beta amyloid. Results: Both versions showed good item discrimination. Ethnicity did not affect scores when controlling for diagnosis and education. Both versions classified CN and dementia, and positively correlated to beta amyloid. Conclusions: Results suggest FAQ-6 and FAQ-10 similarly predict diagnosis and is adequate in these ethnic groups. / Includes bibliography. / Thesis (M.A.)--Florida Atlantic University, 2018. / FAU Electronic Theses and Dissertations Collection

Cognitive impairment after stroke or transient ischemic attack (TIA) is a prototype of vascular cognitive impairment (VCI). 30% of subjects with poststroke cognitive impairment are detected Alzheimer’s disease (AD)-like amyloid-beta (Aβ) retention with reference to ¹¹C-Pittsburgh compound B (PiB) positron emission tomography (PET). Therefore, poststroke cognitive impairment provides a good clinical context for the study about contribution of comorbid Alzheimer’s and cerebrovascular disease (CVD) pathologies to cognition. In this thesis, there are four studies addressing the effect of Aβ on poststroke cognitive impairment. / The first study investigated the accuracy of diagnosing cognitive impairment subtype in subjects with stroke/TIA using current clinical diagnostic criteria with reference to ¹¹C-PiB PET. We found the agreement between the pre and the post-PET diagnoses was poor (Kappa=0.194). The overall accuracy of clinical diagnosis of pure VCI (pVCI) was 66.7%, while that of mixed (i.e., AD with CVD) VCI (mVCI) was 68.0%. / Dementia may occur after stroke/TIA within 3-6 months (early poststroke dementia [PSD]) or from 3-6 months onward (delayed PSD). In the second study, apart from age and history of diabetes mellitus, chronic small vessel disease (SVD) lesions including lacunes and white matter changes (WMC) predicted delayed PSD as they did for early PSD. With comparable levels of SVD, the presence of acute infarcts and AD-like Aβ retention were associated with the early dementia after stroke/ TIA. / So far, there is a lack of research on the long-term effect of Alzheimer’s pathology on cognitive impairment in the context of stroke/TIA. We hypothesized that comorbid AD-like Aβ deposition played a key role in progressive cognitive decline after stroke/TIA. To test this hypothesis, we conducted a 3-year longitudinal study as study 3. Over 3 years, there was significant difference between mVCI and pVCI on the changes of the Mini-Mental State Examination (MMSE) score over time. We observed a significant decline in MMSE in the mVCI group but not the pVCI group. The annual rates of decline in MMSE and Montreal Cognitive Assessment (MoCA) score were greater in the mVCI group compared to the pVCI group. Of all MoCA domains measured, memory, executive and visuospatial functions were related to Aβ deposition. / In study 4, we investigated the relative contribution of Aβ deposition and CVD lesions to neuropsychological profiles in subjects with cognitive impairment after stroke/TIA. We found that in mVCI, Aβ retention in deep region or parietal lobe was predominantly associated with memory or executive function, respectively. In pVCI, frontal WMC and global large acute infarcts could affect memory or executive function via brain atrophy. / The conclusion of these studies reported herein can be summarized as follows: First, the overall accuracy of clinical diagnosis for cognitive impairment subtypes after stroke/TIA was low. Second, subjects with AD-like Aβ deposition tended to have dementia early after stroke/TIA, and they were more likely to experience a continuous and more severe cognitive decline 3 years later. Finally, Aβ deposition could affect both memory and executive function directly as a predominant factor in subjects with mixed Alzheimer’s and CVD pathologies. / 中風或短暫性腦缺血發作後的認知障礙被普遍視為血管性認知障礙的一種原型。通過澱粉樣蛋白正電子發射計算機斷層掃描技術（¹¹C-PiB PET），30%的中風或短暫性腦缺血發作後認知障礙患者具有阿爾茲海默氏病型的澱粉樣蛋白(Aβ)沈積。因此，中風或短暫性腦缺血發作後認知障礙是一種研究共存的阿爾茲海默氏病和腦血管疾病對認知功能的影響的良好模型。該論文通過四個研究，闡述了Aβ對中風或短暫性腦缺血發作後認知功能的影響。 / 第一個研究通過藉助¹¹C-PiB PET,調查了臨床診斷中對中風或短暫性腦缺血發作後認知障礙的分型的準確性。我們發現，對不同認知障礙類型的臨床診斷準確率較低（Kappa=0.194）。其中，對血管性認知障礙的臨床診斷準確率為66.7％，對混合性(阿爾茲海默氏病和腦血管疾病混合型)認知障礙的臨床診斷準確率為68.0％。 / 通常，我們把於中風或短暫性腦缺血發作後3至6個月內發生的癡呆定義為早髮型中風或短暫性腦缺血發作後癡呆，3至6個月后發生的癡呆定義為晚髮型中風或短暫性腦缺血發作後癡呆。在第二個研究中，我們發現，慢性小血管病（腔隙性梗塞和腦白質病變）不僅可以導致早髮型中風或短暫性腦缺血發作後癡呆，而且和晚髮型中風或短暫性腦缺血發作後癡呆也有關聯。然而，如果在相同程度的小血管病損傷的情況下，具有急性缺血性損傷和阿爾茲海默氏型Aβ沈積的患者更易提早發生中風或短暫性腦缺血發作後癡呆。 / 迄今，尚無關於共存的阿爾茲海默氏病和腦血管疾病對認知功能的長期影響的研究。我們假設合併的阿爾茲海默氏病可以導致患者中風或短暫性腦缺血發作後認知功能持續下降。為了驗證這一假設，我們進行了一個為期3年的長期隨訪研究（研究三）。在三年的隨訪中，混合性認知障礙患者和血管性認知障礙患者的簡短認知檢測（MMSE）評分變化有著顯著不同：混合性認知障礙患者的MMSE評分顯著下降，而血管性認知障礙患者的MMSE評分則無明顯改變。而且，混合性認知障礙患者的MMSE和蒙特利爾認知評估量表（MoCA）評分每年下降的平均速度皆高於血管性認知障礙患者。此外，藉助MoCA，我們發現中風或短暫性腦缺血發作後認知障礙患者的記憶、執行能力和視覺空間能力的損傷都和Aβ沉積有關。 / 在第四個研究中，我們研究了Aβ和腦血管病損傷對中風或短暫性腦缺血發作後患者不同認知功能的影響。我們發現，在混合性認知障礙患者中，腦深部的Aβ沉積和記憶功能損害直接相關，腦頂葉的Aβ沉積則和執行功能損害直接相關。在血管性認知障礙患者中，額葉腦白質病變和全腦大型腦梗病灶則可通過腦萎縮的介導，影響記憶或執行功能。 / 總之，我們的研究發現: 1.目前關於中風或短暫性腦缺血發作後患者認知障礙分型的臨床診斷的準確性較低。2.具有阿爾茲海默氏型Aβ沉積的患者不僅易於在中風或短暫性腦缺血發作後早期發生認知障礙，而且其認知水平在長期隨訪中也會不斷下降。3. Aβ沉積可以作為主導因素直接影響混合性認知障礙患者的記憶和執行功能。 / Liu, Wenyan. / Thesis Ph.D. Chinese University of Hong Kong 2015. / Includes bibliographical references (leaves 164-187). / Abstracts also in Chinese; appendixes in Chinese. / Title from PDF title page (viewed on 12, October, 2016). / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only.

MMed, Internal Medicine, Faculty of Health Sciences,University of the Witwatersrand / Aims: To determine whether impairment of the executive functioning domain of cognition could be detected by a battery of simple bedside cognitive tests of executive function associated with inadequate glycaemic control. Methods: People with type 2 diabetes attending a tertiary referral diabetic clinic who consented to participate in the study underwent a brief battery of cognitive testing (the Bedside Executive Screening Test) designed to detect executive function impairment. Glycaemic control was determined using glycated haemoglobin levels (HbA1c). Inadequate glycaemic control was defined as HbA1c ≥ 7.0%. Results: Executive function impairment was detected in 51 (52%) of the 98 study participants. The presence of executive function impairment was significantly associated with poor glycaemic control (HbA1c ≥ 7.0%) (odds ratio 4.9, 95% confidence interval 1.3 – 18.8, p=0.019). There were no significant differences between patients with and without executive function impairment with regard to age, target organ damage, patient reported adherence, and hypoglycaemic therapy. Patients with a lower level of education were more likely to demonstrate executive impairment when glycaemic control was poor (p=0.013). Conclusion: Executive function impairment is common in a population of people with difficult-to-manage type 2 diabetes. The presence of executive impairment is significantly associated with poor glycaemic control.

Indiana University-Purdue University Indianapolis (IUPUI) / Up to 75% of the more than 3.5 million breast cancer survivors (BCS) living in the United States report cognitive dysfunction. However, little is known about cognitive dysfunction among older BCS, who may be at greater risk. Therefore, the purpose of this dissertation was to characterize cognitive dysfunction in older BCS. Specific aims included: (1) synthesize the literature regarding cognitive dysfunction in older BCS; and (2) examine the relationships between a) objective cognitive function (immediate memory, delayed memory, attention, executive function-working memory, verbal fluency) and subjective cognitive function (attention); b) demographic factors, medical factors, treatment factors, and cancer-related symptoms (depressive symptoms, anxiety, fatigue, sleep disturbance) and cognitive function; and c) comorbidity and cognitive function and physical functioning, and quality of life (QoL) in older BCS. In an integrative review, to address aim 1, 12 studies were identified. Up to 41% of older BCS showed objective cognitive dysfunction on neuropsychological assessment, up to 64% reported subjective cognitive dysfunction concerns pre-treatment, and 50% incurred cognitive decline from pre- to post-treatment. Cognitive dysfunction was associated with older age, multiple comorbidities, chemotherapy, sleep disturbance, neuropsychological symptom cluster, frailty, and poorer QoL. To address aim 2, data were leveraged from a large, nationwide, QoL in younger versus older BCS study (PI: Champion), which included 335 older BCS who were ≥60 years of age, had breast cancer (stage I-IIIa), received chemotherapy, and were 3-8 years post-diagnosis without recurrence. Findings included up to 19% of older BCS had mild-moderate objective cognitive dysfunction on at least one neuropsychological assessment, with 26% reporting poor-moderate subjective attention function. BCS, who were older, had less education and more depressive symptoms had greater cognitive dysfunction. Objective attention and executive function-working memory significantly and positively correlated with subjective attention. In turn, subjective cognitive dysfunction and increased number of comorbidities were related to poorer physical functioning. Subjective cognitive dysfunction was also related to poorer QoL. The findings from this study highlights the prevalence and complexity of cognitive dysfunction in older BCS. Further research is needed to better understand the intersection of aging, cancer, comorbidities and cognitive dysfunction and the negative implications in older BCS.

Abstract: Determine the level of concordance between the Mini-Mental State Examination (MMSE), Short Portable Mental State Examination (SPMSQ), and Montreal Cognitive Assessment (MoCA) screening test for cognitive impairment in older adults. A cross-sectional study based on an original cohort study. 1683 patients over 60 years-old were included between 2010 and 2015. Demographic information was collected and the MMSE, MoCA, and SPMSQ scores were obtained. Categorical variables were presented as frequencies and percentages, while numerical ones as median and interquartile range. The agreement was measured and adjusted by the number of years of education by Cohen’s Kappa index (k) with a 95% confidence interval (CI). The agreement was considered as good if k > 0.80. MMSE classified 43.32% of the patients as having cognitive impairment, MoCA 43.14%, and SPMSQ 24.84%. MMSE and MoCA showed an agreement (k) of 0.99 with a 95% CI of 0.99–1.00; MoCA and SPMSQ showed a k of 0.43 (95% CI: 0.38–0.46). Finally, MMSE and SPMSQ showed a k of 0.42 (95% CI: 0.37–0.46). The results did not change when performing the analysis by education subgroups. There was a strong concordance between MoCA and MMSE tests. Nevertheless, the SPMSQ was discordant with the other tests. / Revisión por pares